腹膜后腹腔镜与EMS标准单通道经皮肾镜治疗肾盂单发较大结石临床分析

Retroperitoneal laparoscopic pyelolithotomy and EMS percutaneous nephrolithotomy in the treatment of solitary large renal pelvic stone

目的分析腹膜后腹腔镜肾盂切开取石术和EMS标准单通道经皮肾镜取石术治疗肾盂单发较大结石的临床效果。方法单侧肾盂单发较大结石患者98例,49例采用腹膜后腹腔镜肾盂切开取石术治疗者为观察组,49例行EMS标准单通道经皮肾镜碎石取石术者为对照组,比较2组手术时间、术中出血量、结石清除率、术后输血率及发热发生率、术后住院时间。结果观察组手术时间为(140.04±35.51)min,术中出血量为(59.12±12.89)mL,结石清除率为100.0%,对照组分别为(60.06±18.33)min、(189.08±112.69)mL、89.8%,2组比较差异有统计学意义(P<0.05);观察组术后输血率(0)、发热发生率(4.08%)及术后住院时间((4.96±0.79)d)均低于对照组(12.24%、20.41%、(5.76±0.83)d)(P<0.05)。结论腹膜后腹腔镜肾盂切开取石具有出血少、结石清除率高、术后并发症少、住院时间短等优势,可作为肾盂单发较大结石的可选术式。

Objective To explore the therapeutic effect of retroperitoneal laparoscopic pyelolithotomy（LRP）and EMS standard tract percutaneous nephrolithotomy（PCNL）on solitary large renal pelvic stones.Methods Ninety-eight patients with solitary large renal pelvic stones were divided into observation group（n=49）undergoing LRP and control group（n=49）undergoing PCNL.The mean operation duration,mean blood loss,stone clearance rate,blood transfusion rate,incidence of fever,and postoperative hospitalization stay were compared between two groups.Results The operation duration,blood loss and stone clearance rate were（140.04±35.51）min,（59.12±12.89）mL and 100.0% in observation group,and were（60.06±18.33）min,（189.08±112.69）mL and 89.8% in control group,showing significant differences between two groups（P〈0.05）.The blood transfusion rate,incidence of fever and postoperative hospitalization stay were lower in observation group（0,4.08%,（4.96±0.79）days）than those in control group（12.24%,20.41%,（5.76±0.83）days）（P〈0.05）.Conclusion With the advantage of less bleeding,high stoneclearance rate,few postoperative complications and short postoperative hospitalization stay,LRP is a feasible surgical technique for patients with solitary large renal pelvic stones.